PUBLIC PRIVATE PARTNERSHIP IN HEALTH INDUSTRY AND THE FATE OF DELTANS

By Hilary Chidi Ugwuoke

Mr Johnson (not his real name) was a patient in one of the General Hospitals in Delta State and he was greatly troubled as he just had a referral to Delta State University Teaching Hospital (DELSUTH) Oghara for further management. The wife seated at the corner of the bed was deep in thought looking at no one in particular.

“We can’t afford the cost” She said, shaking her head as tears flowed freely.

“We may try one of the prayer houses”. She said resignedly, cleaning her nose.

A bystander wondered whether DELSUTH is different from other Hospitals owned by Delta State Government.

The nurse clarified that part of the services like radiology and the laboratory has been privatised under public private partnership (PPP), and that the cost of ordinary malaria and widal (typhoid) test at DELSUTH is two thousand, three hundred naira as against eight hundred naira being charged for the same test at Central hospitals.

If Deltans are lamenting about the increase in health cost due to public private partnership, they will cry for a long time as memorandum of understanding has been signed for the public private partnership of the new 250 bed Government Hospital Asaba!

The present government of Delta State has prided itself as people friendly with good health programmes like the free maternal health, free under five treatment and other health programmes aimed at pushing the agenda: HEALTH FOR ALL DELTANS.

His Excellency, the Governor of Delta State, Senator Dr Ifeanyi Okowa, while addressing Deltans during the grand finale of 05 initiative at Asaba said, “we will work with the people to develop the State, continue to pray for us, prosperity is for all Deltans, as a government we are not to share money but, to develop our State, execute projects and programmes that will empower the people and make them happy.”

If privatising Radiology and Laboratory department of General hospital Asaba to a company that is not a donor agency or not-for-profit organisation, is part of the projects and programmes that will make Deltans happy, then the government is being ill-advised.

The company is a core business organisation that thrives on profits and wants a good return on their investment. Deltans are helplessly going to pay for these returns!

Partnership with the private sector is not a new idea.

In 1993, World Health Assembly Resolution urged the World Health Organization (WHO), to mobilize and encourage the support of all partners in health development, including nongovernmental organizations and institutions in the private sector.

The WHO describes public–private partnerships (PPPs) for health as “public sector programmes with private sector participation” a vague definition that allows for many shapes and sizes of PPPs.

The most prominent and mostly used PPP in health sector is “contracting”. With different mode, like contracting in, contracting out, service contract, operations and management contract, and capital projects with operation and maintenance contract.

The model chosen is dependent on the assessment of the local needs of each State or Nation. However it must be noted that these partnerships are susceptible to challenges notable among them are equity, quality and cost.

The present Delta model of PPP failed the test of cost, the test of quality and the test of equity!  In this model, cost is increased, quality might be compromised because profit is the primary aim; and there is no equity because only two departments in the whole hospital are targeted for privatization.

It should be noted that Government reliance on private sector for healthcare delivery is an acknowledgement that government does not trust entirely its own system, however in adopting  a PPP model,  care should be taken to ensure that Delta citizens are protected in terms of costs, quality of healthcare and personnel employment. Private partnership is good only if it is done without malice!

The most appealing PPP may be by way of operations and management contract where government signs a memorandum of understanding with Equipment manufacturers and distributors whose responsibility is to provide upgraded medical equipment, and facility management. The government allows the equipment manufacturer to bring in, install and manage the equipment for a period of time in order to recoup the cost of the equipment, at the same time training government staff to take over at the expiration of the contract. This kind of partnership which provides medical training component will improve availability of well- trained healthcare professionals, thereby promoting quality healthcare delivery at a reasonable cost to the citizenry.

In all, there is need for performance monitoring that includes provision for payment and penalty in lieu of performance outcomes in terms of services rendered. There should be an independent monitor who will be jointly appointed by the Government and the private partner. The monitor will be doing a quarterly evaluation of the performance of the private partner which is linked with the desired output achievements.

The organization should be skilled in human resource management and should also be more creative with health promotion activities. Above all, they should be able to foster a better relationship with the beneficiary communities.

The intention of PPP is to complement government efforts at healthcare delivery at a reduced cost with undiluted quality. This present model is not a reflection of what this present government stands for in terms of achieving the agenda of health for all Deltans.

It becomes imperative that the Government should as a matter of urgency revisit this model, engage all stakeholders and come out with a well-structured private partnership capable of strengthening the health system. This if timely done will save lives and promote Delta State as a role model capable of  reducing capital flight through medical tourism.

This is the only way to go.

Hilary Chidi Ugwuoke, a social commentator lives in Agbor Delta State.